Uterine fibroids: When “R”, a 47-year-old woman from the USA, walked into our clinic, she described a few weeks of lower-abdominal heaviness and recent urinary discomfort, needing to pass urine often, yet never feeling empty.
On examination, her uterus felt enlarged, roughly what we’d expect at 6 months of pregnancy. An MRI confirmed multiple fibroids pressing on the ureters (the tubes draining the kidneys), causing early hydronephrosis. Within 24 hours of a planned hysterectomy, her urinary symptoms lifted, and she went home comfortably a few days later.
I’m sharing R’s story not because every fibroid behaves this way, but because it perfectly illustrates how size and location and not just the word “fibroid”, determine symptoms and the best treatment plan.
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What Are Uterine Fibroids and Why Do Some Cause Big Problems?
Uterine fibroids (leiomyomas) are benign muscle tumours of the uterus. Many are small and quiet; others cause heavy periods, pressure, pain, urinary or bowel changes, and sometimes fertility issues. In R.’s case, bulk and position were the culprits: large fibroids crowding the pelvis and compressing the ureters, which is why her bladder felt “never empty” and her kidneys were under back-pressure.
Uterine Fibroids: Types & Locations
- Intramural: in the uterine muscle; common; can cause heavy bleeding and pain during periods.
- Submucosal: jut into the cavity; small but mighty for heavy/prolonged bleeding, anaemia, and fertility problems.
- Subserosal: grow outward; more pressure (bloating, urinary/bowel symptoms) than bleeding.
- Pedunculated: on a stalk; can twist and cause acute pain.
- Cervical: in/on the cervix; may bleed or obstruct.
How R. fits: Her dominant lesions were intramural/subserosal, posterior and lateral, pushing on the ureters, an anatomic reason for urinary frequency and incomplete emptying.
Size Matters (Clinically, Not Just in Centimetres)
- Small <3 cm (often incidental)
- Medium 3–7 cm
- Large >7 cm or a uterus enlarged to >14–16 weeks in size
R.’s uterus measured around a “6-month” size on exam, classic bulk symptoms and a higher chance of pressure effects on nearby organs.
Uterine Fibroids: Symptoms to Watch
- Menstrual: heavy/prolonged flow, clots, anaemia (not R.’s main issue)
- Pressure/bulk: abdominal distension, pelvic pressure (✓)
- Urinary: frequency, urgency, poor stream, retention (✓)
- Bowel: constipation, incomplete evacuation
- Pain: cramping, deep pelvic ache; sudden pain if degeneration/torsion
- Fertility/pregnancy: depends on size/location (submucosal most impactful)
- Red flags (seek care promptly): escalating urinary difficulty, flank pain (possible hydronephrosis), severe anaemia symptoms, sudden severe pelvic pain, very rapid growth.
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Uterine Fibroids: How We Diagnosed (and Plan)
- Pelvic exam to estimate size/contour
- Ultrasound to map number, size, and site (first-line)
- MRI for complex cases/surgical planning (critical in R.’s case to see ureteric compression)
- Labs for anaemia; hormonal tests as indicated
Treatment of Uterine Fibroids: Matching the Plan to the Patient
Your goals (control bleeding, relieve pressure, preserve fertility, avoid surgery, protect kidneys) guide choices.
Watchful Waiting:
For small, asymptomatic fibroids. Regular monitoring.
Medical Therapy:
- Controls bleeding/pain; may shrink temporarily:
- NSAIDs, tranexamic acid for heavy periods
- Hormonal options (combined pills, progestins, LNG-IUD if cavity allows)
- GnRH agonists/antagonists (short-term shrinkage, pre-op or perimenopause)
- Iron for anaemia
- Note: Medicines don’t remove fibroids; symptoms can recur when stopped.
Uterus-Preserving Procedures:
- Hysteroscopic myomectomy for submucosal fibroids
- Laparoscopic/open myomectomy for intramural/subserosal lesions (recurrence possible)
- Uterine artery embolisation (UAE) to shrink fibroids (generally not the first choice if future pregnancy is a priority)
- MR-guided focused ultrasound (MRgFUS) in select cases
Definitive Surgery:
Hysterectomy is curative for fibroids and ideal when there’s refractory bleeding, disabling bulk symptoms, rapid regrowth, or complications like ureteric compression.
Why R. chose surgery: Kidney safety trumps everything. Timely hysterectomy relieved the obstruction and protected renal function. Histology showed degenerating fibroids; recovery was smooth with minimal blood loss.
Uterine Fibroids: Aftercare & Long-Term Health
- Reassess symptoms, iron levels (if anaemic), and healing
- Monitor for recurrence after myomectomy/UAE
- Keep up with routine breast, cervical, and ovarian screening
- Discuss perimenopausal care and bone/cardiometabolic health
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Fibroids are benign, but their impact depends on where they are and how big they get. Heavy bleeding and pelvic pressure are common; urinary complaints deserve special attention because they can signal ureteric compression and potential kidney risk. R.’s quick recovery after targeted treatment is exactly what personalised planning aims for: the right intervention, at the right time, for the right reason.
If you notice persistent bloating/pressure, new urinary symptoms, or heavy bleeding, don’t wait. A focused evaluation, often just an ultrasound, can turn weeks or months of discomfort into a clear, effective plan tailored to you.
Health disclaimer: This article is for education only and is not a substitute for personalised medical advice. For symptoms, medications, or screening decisions, consult your doctor.